Medical device data integration apparatus and methods

ABSTRACT

Methods, systems, and apparatuses for integrating medical device data are disclosed. In an example embodiment, an integration engine includes a configuration interface configured to receive a patient identifier. The integration engine also includes a subscription processor configured to transmit a first message, including the patient identifier, to a first gateway to receive infusion therapy progress data from at least one infusion pump and transmit a second message, including the patient identifier, to a second gateway to receive renal failure therapy progress data from at least one renal failure therapy machine. The integration engine further includes a data processor configured to receive the infusion therapy progress data from the first gateway, receive the renal failure therapy progress data from the second gateway, and cause a combination user interface to display the infusion therapy progress data and the renal failure therapy progress data.

PRIORITY CLAIM

The present application is a divisional of U.S. patent application Ser.No. 15/235,701, filed Aug. 12, 2016, which claims priority to U.S.Provisional Patent Application No. 62/205,104, filed on Aug. 14, 2015,the entirety of which is incorporated herein by reference and reliedupon.

BACKGROUND

Hospitals use different types of medical devices from differentmanufacturers. While the medical devices are configured to communicateover the same network (e.g., a local area network (“LAN”)), the formatof the data from each device is different. Each medical device developermay have their own proprietary format that is believed to be superior toother formats. Device developers attempt to gain wide-spread use oftheir proprietary data formats to restrict other developers fromentering a hospital system or to obtain licensing payments from otherdevelopers that also desire to use the same data format. Even developersthat use a standard data format, such as Health Level 7 (“HL7”), maystill use customized data fields and definitions to make it difficultfor other developers to integrate their medical devices into the samesystem.

In one example, a hospital system may select to use infusion pumps froma first developer. The data from the infusion pumps is formatted using aproprietary format. The use of the proprietary format forces thehospital to spend millions of dollars and months of time to develop aninterface to enable the data from the infusion pumps to be compatiblewith the rest of the system. An interface may, for example, convert theinfusion pump data into a format for inclusion within electronic medicalrecords or transmission to user interface devices, such as a centralizedmonitoring system or clinician tablet computers/smartphones. Theinterface may also convert data originating in the hospital system intoa format that is compatible with the infusion pump. For example, anelectronic infusion therapy prescription from a pharmacy managementsystem may be converted into a format that is recognized by an infusionpump.

As one can appreciate, the use of proprietary data formats andspecialized interfaces make it difficult or almost impossible formedical devices to share or integrate data. This would require, forexample, medical device developers to create separate interfaces fortheir devices that are compatible with every possible proprietary dataformat. Alternatively, the hospital system would have to createadditional specialized interfaces. Given the number of different typesof medical devices (e.g., infusion pumps, dialysis or renal therapymachines, physiological sensors/vital sign monitors, medical scanners,etc.), this is an almost impossible task.

SUMMARY

An example system, method, and apparatus are disclosed herein, whichconcurrently display data from different types of medical devices withina single display or user interface. The example system, method, andapparatus are configured with an integration engine that is speciallyprogrammed to convert data from multiple medical devices into a commonformat or protocol. The conversion of data from multiple devices intoone format enables the data to be displayed concurrently within one userinterface. The conversion of the data from multiple devices into oneformat also enables calculations or routines to be performed todetermine relationships between the different types of data. Forexample, infusion data, renal failure therapy data, and urine collectiondata may be analyzed together to determine a patient's fluid balance. Inother examples, the different types of data may be collectively analyzedto determine trends that may not be apparent by analyzing data from onemedical device or sensor. Further, the integration of data fromdifferent devices enables the modification or adjustment of certaindevice limits or alarm limits.

Aspects of the subject matter described herein may be useful alone or incombination with one or more other aspect described herein. Withoutlimiting the foregoing description, in a first aspect of the presentdisclosure, a networked healthcare system comprises a renal failuretherapy machine communicatively coupled to a hospital information systemconfigured to perform a renal failure therapy treatment for a patient,determine at least one renal failure therapy parameter related to therenal failure therapy treatment including an ultrafiltration rate atwhich fluid is removed from the patient, determine a renal failuretherapy timestamp for the at least one renal failure therapy parameter,and transmit the at least one renal failure therapy parameter, a patientidentifier of the patient, and the renal failure therapy timestamp tothe hospital information system. The system also comprises an infusionpump communicatively coupled to the hospital information systemconfigured to perform an infusion treatment for the same patientconcurrently with the renal failure therapy machine, determine at leastone infusion parameter related to the infusion treatment including aninfusion rate at which fluid is infused into the patient, determine aninfusion timestamp for the at least one infusion parameter, and transmitthe at least one infusion parameter, the patient identifier, and theinfusion timestamp to the hospital information system. The systemfurther comprises a vital sign monitor associated with the patientcommunicatively coupled to the hospital information system, andoperating in conjunction with an integration engine, configured toreceive the at least one renal failure therapy parameter, the patientidentifier, and the renal failure therapy timestamp, receive the atleast one infusion parameter, the patient identifier, and the infusiontimestamp, determine the at least one renal failure therapy parameterand the at least one infusion parameter are to be displayed at acombination user interface based on the patient identifier, determine adifference parameter based on a difference between the at least oneinfusion parameter and the at least one renal failure therapy parameter,display, within the combination user interface, the at least one renalfailure therapy parameter within a renal failure therapy timeline,display, within the combination user interface, the at least oneinfusion parameter within an infusion timeline that is temporallyaligned in parallel with the renal failure therapy timeline, anddisplay, within the combination user interface, the difference parameterwithin a difference timeline that is temporally aligned in parallel withthe renal failure therapy timeline and the infusion timeline.

In accordance with a second aspect of the present disclosure, which maybe used in combination with any other aspect listed herein unless statedotherwise, the networked healthcare system further comprises a monitorgateway engine configured to receive the at least one renal failuretherapy parameter, the patient identifier, and the renal failure therapytimestamp from the renal failure therapy machine, receive the at leastone infusion parameter, the patient identifier, and the infusiontimestamp from the infusion pump, determine the vital sign monitor amonga plurality of vital sign monitors that is associated with the patientidentifier, transmit the at least one renal failure therapy parameter,the patient identifier, and the renal failure therapy timestamp to thedetermined vital sign monitor, and transmit the at least one infusionparameter, the patient identifier, and the infusion timestamp to thedetermined vital sign monitor.

In accordance with a third aspect of the present disclosure, which maybe used in combination with any other aspect listed herein unless statedotherwise, the networked healthcare system further comprises a renalfailure therapy gateway engine configured to receive the at least onerenal failure therapy parameter, the patient identifier, and the renalfailure therapy timestamp from the renal failure therapy machine,determine the at least one renal failure therapy parameter, the patientidentifier, and the renal failure therapy timestamp are to betransmitted to the monitor gateway engine, and transmit the at least onerenal failure therapy parameter, the patient identifier, and the renalfailure therapy timestamp to the monitor gateway engine.

In accordance with a fourth aspect of the present disclosure, which maybe used in combination with any other aspect listed herein unless statedotherwise, the networked healthcare system further comprises an infusiongateway engine configured to receive the at least one infusionparameter, the patient identifier, and the infusion timestamp from theinfusion pump, determine the at least one infusion parameter, thepatient identifier, and the infusion timestamp are to be transmitted tothe monitor gateway engine, and transmit the at least one infusionparameter, the patient identifier, and the infusion timestamp to themonitor gateway engine.

In accordance with a fifth aspect of the present disclosure, which maybe used in combination with any other aspect listed herein unless statedotherwise, the vital sign monitor is communicatively coupled to aphysiological sensor and configured to receive at least onephysiological parameter from the physiological sensor and display,within the combination user interface, the at least one physiologicalparameter within a physiological timeline that is temporally aligned inparallel with the renal failure therapy timeline and the infusiontimeline.

In accordance with a sixth aspect of the present disclosure, which maybe used in combination with any other aspect listed herein unless statedotherwise, the vital sign monitor is configured to transmit the at leastone physiological parameter to at least one of the renal failure therapymachine or the infusion pump via the monitor gateway engine.

In accordance with a seventh aspect of the present disclosure, which maybe used in combination with any other aspect listed herein unless statedotherwise, the vital sign monitor is configured to display the at leastone renal failure therapy parameter, the at least one infusionparameter, and the difference parameter as a numerical value adjacent tothe respective timeline.

In accordance with an eighth aspect of the present disclosure, which maybe used in combination with any other aspect listed herein unless statedotherwise, the infusion pump is a first infusion pump and the networkedhealthcare system further comprising a second infusion pumpcommunicatively coupled to the hospital information system configured toperform a second infusion treatment for the same patient concurrentlywith the first infusion pump, determine at least one second infusionparameter related to the second infusion treatment including a secondinfusion rate at which a second fluid is infused into the patient,determine a second infusion timestamp for the at least one secondinfusion parameter, and transmit the at least one second infusionparameter, the patient identifier, and the second infusion timestamp tothe hospital information system, wherein the vital sign monitoroperating in conjunction with the integration engine is configured toreceive the at least one second infusion parameter, the patientidentifier, and the second infusion timestamp, determine the differenceparameter based on a difference between the at least one infusionparameter, the at least one second infusion parameter, and the at leastone renal failure therapy parameter, determine more than one infusiontreatment is being provided to the patient, display, within thecombination user interface, the at least one second infusion parameterwithin a second infusion timeline that is temporally aligned in parallelwith the infusion timeline, and display, within the combination userinterface, a first name of the fluid infused by the first infusion pumpadjacent to the infusion timeline and a second name of the second fluidinfused by the second infusion pump adjacent to the second infusiontimeline.

In accordance with a ninth aspect of the present disclosure, which maybe used in combination with any other aspect listed herein unless statedotherwise, the at least one difference parameter includes a net amountof fluid change within the patient per a time period.

In accordance with a tenth aspect of the present disclosure, which maybe used in combination with any other aspect listed herein unless statedotherwise, the at least one renal failure therapy parameter includes arate at which fluid is added to the patient from the renal failuretherapy machine, a total amount of fluid removed from the patient, anamount of time remaining for the renal failure therapy treatment, and anevent associated with the renal failure therapy treatment.

In accordance with an eleventh aspect of the present disclosure, whichmay be used in combination with any other aspect listed herein unlessstated otherwise, the at least one infusion parameter includes atimestamp, a drug name of the fluid infused into the patient, a totalamount of fluid infused into the patient, an amount of time remainingfor the infusion treatment, an event associated with the infusiontreatment, and a drug limit for the infusion treatment.

In accordance with a twelfth aspect of the present disclosure, which maybe used in combination with any other aspect listed herein unless statedotherwise, a vital sign monitor apparatus comprises a renal failuretherapy interface configured to receive at least one renal failuretherapy parameter, a patient identifier, and a renal failure therapytimestamp from a renal failure therapy machine performing a renalfailure therapy treatment for a patient associated with the patientidentifier, an infusion pump interface configured to receive at leastone infusion parameter, the patient identifier, and an infusiontimestamp from an infusion pump performing an infusion treatment for thesame patient, and a vital sign monitor engine communicatively coupled tothe renal failure therapy interface and the infusion pump interface, thevital sign monitor engine configured to determine the at least one renalfailure therapy parameter and the at least one infusion parameter are tobe displayed in a combination user interface based on the patientidentifier, display, within the combination user interface, the at leastone renal failure therapy parameter within a renal failure therapytimeline, and display, within the combination user interface, the atleast one infusion parameter within an infusion timeline that istemporally aligned in parallel with the renal failure therapy timeline.

In accordance with a thirteenth aspect of the present disclosure, whichmay be used in combination with any other aspect listed herein unlessstated otherwise, an infusion pump apparatus comprises a renal failuretherapy interface configured to receive at least one renal failuretherapy parameter, a patient identifier and a renal failure therapytimestamp from a renal failure therapy machine performing a renalfailure therapy treatment for a patient associated with the patientidentifier, an infusion treatment processor configured to perform aninfusion treatment for the same patient concurrently with the renalfailure therapy machine, determine at least one infusion parameterrelated to the infusion treatment including an infusion rate at whichfluid is infused into the patient, and determine an infusion timestampfor the at least one infusion parameter. The infusion pump apparatusalso includes an infusion display engine configured to determine the atleast one renal failure therapy parameter and the at least one infusionparameter are to be displayed at a combination user interface based onthe patient identifier, determine a difference parameter based on adifference between the at least one infusion parameter and the at leastone renal failure therapy parameter, display, within the combinationuser interface, the at least one renal failure therapy parameter withina renal failure therapy timeline, display, within the combination userinterface, the at least one infusion parameter within an infusiontimeline that is temporally aligned in parallel with the renal failuretherapy timeline, and display, within the combination user interface,the difference parameter within a difference timeline that is temporallyaligned in parallel with the renal failure therapy timeline and theinfusion timeline.

In accordance with a fourteenth aspect of the present disclosure, whichmay be used in combination with any other aspect listed herein unlessstated otherwise, a renal failure therapy machine apparatus comprises aninfusion pump interface configured to receive at least one infusionparameter, a patient identifier, and an infusion timestamp from aninfusion pump performing an infusion treatment for a patient associatedwith the patient identifier and a renal failure therapy treatmentprocessor configured to perform a renal failure therapy treatment forthe same patient concurrently with the infusion machine, determine atleast one renal failure therapy parameter related to the renal failuretherapy treatment including an ultrafiltration rate at which fluid isremoved from the patient, and determine a renal failure therapytimestamp for the at least one infusion parameter. The renal failuretherapy machine apparatus also includes a renal failure therapy displayengine configured to determine the at least one renal failure therapyparameter and the at least one infusion parameter are to be displayed ata combination user interface based on the patient identifier, determinea difference parameter based on a difference between the at least oneinfusion parameter and the at least one renal failure therapy parameter,display, within the combination user interface, the at least one renalfailure therapy parameter within a renal failure therapy timeline,display, within the combination user interface, the at least oneinfusion parameter within an infusion timeline that is temporallyaligned in parallel with the renal failure therapy timeline, anddisplay, within the combination user interface, the difference parameterwithin a difference timeline that is temporally aligned in parallel withthe renal failure therapy timeline and the infusion timeline.

In accordance with a fifteenth aspect of the present disclosure, whichmay be used in combination with any other aspect listed herein unlessstated otherwise, a hospital monitoring system apparatus comprises aninfusion pump interface configured to receive at least one infusionparameter and a patient identifier from an infusion pump performing aninfusion treatment for a patient associated with the patient identifier,a renal failure therapy interface configured to receive at least onerenal failure therapy parameter and the patient identifier from a renalfailure therapy machine performing a renal failure therapy treatment forthe same patient, and a vital sign monitor interface configured toreceive at least one physiological sensor parameter and the patientidentifier from a vital sign monitor adjacent to the same patient. Thehospital monitoring system apparatus also includes a monitoring systemdisplay engine configured to determine the at least one renal failuretherapy parameter, the at least one infusion parameter, and the at leastone physiological sensor parameter are to be displayed at a combinationuser interface based on the patient identifier, determine a differenceparameter based on a difference between the at least one infusionparameter and the at least one renal failure therapy parameter, display,within the combination user interface, information related to the atleast one renal failure therapy parameter, display, within thecombination user interface, information related to the at least oneinfusion parameter, display, within the combination user interface,information related to the difference parameter, and display, within thecombination user interface, information related to the at least onephysiological sensor parameter.

In accordance with a sixteenth aspect of the present disclosure, any ofthe structure and functionality illustrated and described in connectionwith FIGS. 1 to 15 may be used in combination with any of the structureand functionality illustrated and described in connection with any ofthe other of FIGS. 1 to 15, and with any one or more of the precedingaspects unless stated otherwise.

Additional features and advantages of the disclosed system, method, andapparatus are described in, and will be apparent from, the followingDetailed Description and the Figures.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 shows a diagram of a hospital environment, according to anexample embodiment of the present disclosure.

FIG. 2 shows a diagram of an example infusion pump comprising theBaxter® SIGMA Spectrum pump, which may be implemented within thehospital environment of FIG. 1, according to an example embodiment ofthe present disclosure.

FIG. 3 shows a diagram of an example dialysis or renal failure therapymachine comprising the Gambro® Prismaflex® CRRT machine, which may beimplemented within the hospital environment of FIG. 1, according to anexample embodiment of the present disclosure.

FIG. 4 shows a diagram of a patient monitor displaying data from anintegration engine within the hospital environment of FIG. 1, accordingto an example embodiment of the present disclosure.

FIGS. 5 to 9 show diagrams of the hospital environment of FIG. 1 withthe integration engine operating at different devices, according toexample embodiments of the present disclosure.

FIG. 10 shows a diagram of the example integration engine of FIGS. 1 and5 to 9, according to example embodiments of the present disclosure.

FIGS. 11 and 12 show a flow diagram illustrating an example procedure todisplay medical data from multiple medical devices on a single display,according to an example embodiment of the present disclosure.

FIGS. 13 and 14 show diagrams of the patient monitor of FIG. 4,providing configuration parameters for displaying data from the exampleintegration engine of FIGS. 1 and 5 to 9, according to exampleembodiments of the present disclosure.

FIG. 15 shows a diagram of data conversion provided by one or moreintegration engines within the example hospital environment of FIG. 1,according to example embodiments of the present disclosure.

DETAILED DESCRIPTION

The present disclosure relates in general to a method, system, andapparatus to integrate and concurrently display data from differenttypes of medical devices within a single display or user interface. Theexample method, system, and apparatus are configured to overcome knownlimitations of hospital systems by providing one module, referred toherein as an integration engine, which is configured to improveinteroperability of medical devices by converting data from multipleformats, protocols, or standards into a single format. Despite theefforts of the Integrating the Healthcare Enterprise (“IHE”) initiativeand the Association for the Advancement of Medical Instrumentation(“AAMI”) foundation, there are no national or worldwide standards formedical devices. For example, many infusion pump manufacturers havedifferent standards or protocols for providing point-of-care infusionverification (“PIV”), device enterprise communication (“DEC”), patientidentify binding (“PIB”), and alarm communication management (“ACM”).The result is that infusion data from different types of infusion pumpsmay have different ways in which the data, parameters, or fields arelabeled. The differences may also include the types or units forlabeling the data, how the data is time-stamped, or even how often thedata is transmitted. Medical facilities accordingly typically have toeither use medical devices from one provider (or a group of providersthat use the same standard). These known systems are thereby limited intheir ability to use data form multiple medical devices to construct anoverall health assessment of a patient to provide dynamic deviceprogramming, programming limit adjustment, alarm limit adjustment, oreven the concurrent display of data within a single display or userinterface.

The example integration engine disclosed herein is configured as amodule having multiple interfaces, which are each in turn configured toconvert data from one standard or protocol into a common standard. Theconversion of all the relevant medical data at the integration engineenables the integration engine to be programmed to analyze the differenttypes of data to identify trends, determine differences or correlations,adjust limits/alarms, and/or adjust programming parameters, for example.In addition, the integration engine may be used in conjunction with adisplay device or monitor to visually provide the different types ofmedical data (and derivatives thereof) within one interface. Themodularity of the integration engine enables interface updates to beprovided easily and quickly as different medical devices are introducedinto a system or as data standards or protocols change. Accordingly, theexample integration engine improves overall system interoperability.

In an example, the integration engine is configured to combine infusionpump data with renal failure therapy data to enable a patient monitor toconcurrently display the infusion pump data and renal failure therapydata. The example integration engine may also perform one or morecalculations using the infusion and renal failure therapy data todetermine a fluid balance. The integration engine may further integrateor incorporate the data into one or more algorithms or routines toconcurrently display the data in conjunction with the calculated fluidbalance or derived data to provide a more complete medicalrepresentation of the patient. The integration engine may also use theinfusion pump data and the fluid balance derived data to adjustparameters of the renal failure therapy. Further, the integration enginemay use the infusion pump data, renal failure therapy data, and/or thefluid balance derived data to provide an alarm when, for example, afluid balance exceeds a specified threshold and/or when a renal failuretherapy drain is not scheduled for a certain period of time.

As mentioned above, the example integration engine facilitates thedisplay of different types of medical data, including derivatives,within one interface. As discussed herein, medical data incudes datafrom a medical device, including, for example, therapy progress data,programming instructions/parameters, operational parameters, statusmessages, alarms, alerts, etc. Medical data may also includephysiological or other sensed data. In an example, medical data from aninfusion pump includes an infusion rate, infusion dosage, infusionprogress time, an operational status of the infusion pump (e.g.,paused), a volume of fluid remaining to be infused, an indication ofwhether a drug library limit has been exceeded or overridden, pumpalarms, pump alerts, and/or derivatives thereof.

As discussed herein, derivative data may include a combination ofmedical data received from one or more medical devices that is notdeterminative from any one stream of data alone. The combination maycomprise, for example, adding, subtracting, or performing a specializedprogram or routine that incorporates medical data from one or moredevices. Derivative data may also include an analysis that compares atleast some medical data from one or more medical devices to datadistributions. Derivative data may further include a result fromperforming a statistical analysis of medical data. In some instances,the integration engine may include one or more preconfigured orpre-stored algorithms or routines to determine derivative data. Thepreconfigured derivative data may correspond to most frequently usedtypes of derivative data. In other examples, the example integrationengine may enable a clinician to specify how derivative data is to bedetermined or generated from received medial data. It should beappreciated that disclosed conversion feature of the example integrationengine facilitates the creation of derivative data from different typesof medial data that may be generated in one or more different standardsor protocols. This conversion feature enables data from many differentdevices and standards to be normalized or formatted into one standard orprotocol (oftentimes compatible with the device displaying the data),which enables the multiple, different data streams to be compared,combined, integrated, or analyzed together. Under such a configuration,the integration engine enables the same calculations to be performed anddata to be displayed regardless of the model or manufacturer of themedical devices and/or sensors.

FIG. 1 shows a diagram of a hospital environment 100 configured toimplement the example methods, apparatus, and system described herein,according to an example embodiment of the present disclosure. Theexample environment 100 includes medical devices such as, for example,an infusion pump 102, a dialysis or renal failure therapy (“RFT”)machine 104, a patient monitor 106, and/or one or more physiologicalsensors 108 (e.g., vital sign sensors). It should be appreciated thatthe example hospital environment 100 may include other types of medicaldevices and/or a plurality of pumps 102, RFT machines 104, monitors 106,and/or sensors 108. Collectively, the medical devices are configured toprovide a therapy to a patient 110, read a physiological parameter orvital sign from the patient, and/or display data regarding the patientor treatment.

The example environment 100 also includes an infusion gateway 112, a RFTgateway 114, and a monitor gateway 116. In alternative embodiments, thegateways 112, 114, and 116 may be combined into a single gateway. Inother alternative embodiments, the gateways 112, 114, and 116 may becombined with the respective medical device 102, 104, and 106. Asillustrated in FIG. 1, the infusion gateway 112 and the RFT gateway 114are communicatively coupled to the monitor gateway 116 via a hardwiredconnection and/or a wireless connection (e.g., an Ethernet network, LAN,WLAN, etc.). The gateways 112, 114, and 116 are each communicativelycoupled to a network 118, which may include the same Ethernet network,LAN, WLAN and/or in addition to an external network such as theInternet. The network 118 is communicatively coupled to a hospitalinformation system (“HIS”) 120, one or more medical networks 122, and/orone or more clinician devices 124.

The example infusion pump 102 may include any pump capable of deliveringan intravenous therapy to the patient 110 via one or more line sets.Examples include a syringe pump, a linear peristaltic pump, a largevolume pump (“LVP”), an ambulatory pump, multi-channel pump, etc. Asyringe pump uses a motor connected to a drive arm to actuate a plungerwithin a syringe. A linear peristaltic pump uses a rotor to compresspart of a tube while rotating. Oftentimes, one or more rollers of therotor contact the tube for half a rotation. The compressed rotationcauses a defined amount of fluid to pass through the tube. LVPstypically use one or more fingers or arms to compress a portion ofintravenous therapy (“IV”) tube. The timing of the finger actuation onthe tube causes constant or near constant movement of a fluid throughthe tube.

FIG. 2 shows a diagram of an example infusion pump 102 including theBaxter® SIGMA Spectrum198 pump, according to an example embodiment ofthe present disclosure. The example infusion pump 102 of FIG. 2 includesa display 202 with interfaces 204 a and 204 b to enable a clinician tospecify or program an infusion therapy. Other examples of infusion pumpsinclude a linear volume parenteral pump described in U.S. PublicationNo. 2013/0336814, a syringe pump described in U.S. Publication No.2015/0157791, an ambulatory infusion pump described in U.S. Pat. No.7,059,840, an infusion pump described in U.S. Pat. No. 5,395,320, and aninfusion pump described in U.S. Pat. No. 5,764,034, the entirety of eachare incorporated herein by reference. The infusion pump 102 may alsoinclude the Baxter® Colleague™ volumetric infusion pump.

Returning to FIG. 1, the infusion pump 102 may be configured to receiveelectronic prescriptions (or software updates) from the HIS 120 or otherpharmacy system via the infusion gateway 112. For example, the gateway112 may send an electronic prescription (or software update) to theinfusion pump 102 at a predetermined time and/or when the infusion pump102 is available to accept the prescription. In other instances, theinfusion pump 102 may be configured to periodically poll the gateway 112to determine if an electronic prescription (or software update) isawaiting to be downloaded to the pump. The infusion pump 102 may includea memory storing one or more drug libraries that include particularprogram parameter limits based on care area, dose change, rate ofchange, drug type, concentration, patient age, patient weight, etc. Thelimits are configured to ensure that a received prescription or enteredinfusion therapy is within acceptable ranges and/or limits decided by amedical facility, doctor, or clinician.

The infusion pump 102 is configured to perform an infusion therapy onthe patient 110, which includes infusion of one or more solutions 103 ordrugs into the patient. The infusion pump 102 operates according to aninfusion prescription entered by a clinician at a user interface of thepump (e.g., the interface 204 of FIG. 2) or received via the infusiongateway 112. The infusion pump 102 may compare the prescription to thedrug library and provide any alerts or alarms if a parameter of theprescription violates a soft or hard limit. The infusion pump 102 isconfigured to monitor the progress of the therapy and periodicallytransmit infusion therapy progress data 130 to the gateway 112. Thetherapy progress data 130, as disclosed herein, may include, forexample, an infusion rate, dose, a total volume infused, a timeremaining for the therapy, drug concentration, rate change, a volumeremaining within a medication container, a drug name, a patientidentifier, titration information, bolus information, a care areaidentifier, a timestamp when the data was generated, an alarm condition,an alert condition, an event, etc. The infusion pump 102 may transmitthe data continuously, periodically (e.g., every 30 seconds, 1 minute,etc.), or upon request by the gateway 112.

The infusion gateway 112 of FIG. 1 includes a server, processor,computer, etc. configured to communicate with the infusion pump 102. Theinfusion gateway 112 may include, for example, the Baxter®CareEverywhere gateway. In some embodiments, the gateway 112 may becommunicatively coupled to more than one infusion pump. The infusiongateway 112 is configured to provide bi-directional communication withthe pump 102 for the wired/wireless secure transfer for drug libraries,infusion prescriptions, and therapy progress data 130. The gateway 112may also be configured to integrate with the HIS 120 or other hospitalsystem to facilitate the transmission of the infusion therapy progressdata 130 from the pump 102 to, for example, a hospital electronicmedical record (“EMR”).

The HIS 120 of FIG. 1 is a network system configured in a client-serverarchitecture to facilitate the transmission of medical data, includingthe data 130, 140, and 150 among different medical systems. The HIS 120may include one or more servers configured to process or store medicaldata. The HIS 120 may also include one or more servers for analyzingmedical data or receiving medical data from other portions of thehospital environment 100. The HIS 120 may include, for example a serverfor managing medical data storage to EMRs. The HIS 120 may use a patientidentifier, or similar, to determine which EMR is to receive medicaldata for storage. The HIS 120 may also include or be communicativelycoupled to a laboratory information system, pharmacy system, apolicy/procedure management system, or a continuous quality improvement(“CQI”) system. The laboratory system is configured to generate medicaldata based on analysis of patient biological samples. The pharmacysystem is configured to generate medical prescriptions for a patient,including instructions for programming the infusion pump 102 and/or theRFT machine 104. The policy/procedure management system is configured tomanage drug libraries and/or thresholds for alarms/alerts. The CQIsystem is configured to generate statistical and/or analytical reportsbased on, for example, infusion therapy progress data 130 from one ormore patients. The HIS 120 may also include or be connected to one ormore monitors configured to display at least a portion of the infusiontherapy progress data 130. The HIS 120 may further integrate theinfusion therapy progress data 130, renal failure therapy progress data140, and/or physiological data 150 into clinician documentation toprovide quick and accurate infusion pump documentation and access tonear real-time trends, and contextual patient infusion data thatimproves patient treatment.

The example RFT machine 104 of FIG. 1 may include any hemodialysis,hemofiltration, hemodiafiltration, continuous renal replacement therapy(“CRRT”), or peritoneal dialysis (“PD”) machine. The patient 110,undergoing a renal failure therapy, for example, is connected to the RFTmachine 104, where the patient's blood may be pumped through themachine. The blood passes through a dialyzer of the machine 104, whichremoves waste, toxins and excess water from the blood. The cleaned bloodis returned to the patient. In PD, treatment fluid is delivered to andremoved from a patient's peritoneal cavity to remove toxins and excesswater.

FIG. 3 shows a diagram of an example RFT machine 104 comprising theGambro® Prismaflex® CRRT machine, according to an example embodiment ofthe present disclosure. Other examples of RFT machines 104 include aperitoneal dialysis machine described in U.S. Pat. No. 8,403,880, ahemodialysis dialysis machine described in U.S. Publication No.2014/0112828, and a peritoneal dialysis machine described in U.S.Publication No. 2011/0106002, the entirety of each are incorporatedherein by reference.

CRRT is a dialysis modality typically used to treat emergency orcritically ill, hospitalized patients in an intensive care unit whodevelop acute kidney injury (“AKI”). Unlike chronic kidney disease,which occurs slowly over time, AM often occurs in hospitalized patientsand typically occurs over a few hours to a few days.

Hemodialysis is a renal failure treatment in which waste from the bloodis diffused across a semi-permeable membrane. During hemodialysis, bloodis removed from the patient and flows through a semi-permeable membraneassembly (dialyzer), where the blood flows generally counter-current todialysis solution flowing on the other side of the semipermeablemembrane. In the dialyzer, toxins from the blood travel across thesemi-permeable membrane and exit the dialyzer into used dialysissolution (dialysate). The cleaned blood, having flowed through thedialyzer, is then returned to the patient.

In the dialyzer, a pressure differential is created across thesemi-permeable membrane by removing dialysate at a flow rate that isgreater than that used to introduce the dialysis solution into thedialyzer. This pressure differential pulls fluid containing small,middle, and large molecule toxins across the semi-permeable membrane.Flow and volume measurements are used to control the amount of fluid(ultrafiltration) that is removed. As illustrated above, a hemodialysismachine's pump typically pulls blood from the arterial side of thepatient, pushes it into and through the dialyzer, and through a dripchamber that separates out air, before returning the dialyzed blood tothe venous side of the patient.

The RFT machine 104 can alternatively be a hemofiltration machine.Hemofiltration is another renal failure treatment, similar tohemodialysis. During hemofiltration, a patient's blood is also passedthrough a semipermeable membrane (a hemofilter), wherein fluid(including waste products) is pulled across the semipermeable membraneby a pressure differential. This convective flow brings certain sizes ofmolecular toxins and electrolytes (which are difficult for hemodialysisto clean) across the semipermeable membrane. During hemofiltration, areplacement fluid is added to the blood to replace fluid volume andelectrolytes removed from the blood through the hemofilter.Hemofiltration in which replacement fluid is added to the blood prior tothe hemofilter is known as pre-dilution hemofiltration. Hemofiltrationin which replacement fluid is added to the blood after the hemofilter isknown as post-dilution hemofiltration.

The RFT machine 104 can alternatively be a hemodiafiltration machine.Hemodiafiltration is a further renal failure treatment that useshemodialysis in combination with hemofiltration. Blood is pumped througha dialyzer, which accepts fresh dialysis fluid, unlike a hemofilter.With hemodiafiltration, however, replacement fluid is delivered to theblood circuit, similar to hemofiltration. Hemodiafiltration isaccordingly a neighbor of hemodialysis and hemofiltration.

The RFT machine 104 can alternatively be a peritoneal dialysis machine.Peritoneal dialysis uses a dialysis solution, also called dialysate,which is infused into a patient's peritoneal cavity via a catheter. Thedialysate contacts the peritoneal membrane of the patient's peritonealcavity. Waste, toxins and excess water pass from the patient'sbloodstream, through the peritoneal membrane and into the dialysate duean osmotic gradient created by the solution. Spent dialysate 105 isdrained from the patient, removing waste, toxins and excess water fromthe patient. This cycle is repeated.

An example peritoneal dialysis machine, operating as the RFT machine 104of FIG. 1, may perform various types of additional peritoneal dialysistherapies, including continuous cycling peritoneal dialysis (“CCPD”),tidal flow automated peritoneal dialysis (“APD”), and continuous flowperitoneal dialysis (“CFPD”). APD machines perform drain, fill, anddwell cycles automatically, typically while the patient sleeps. APDmachines free patients or clinicians from having to manually perform thetreatment cycles and from having to transport supplies during the day.APD machines connect fluidly to an implanted catheter, a source or bagof fresh dialysate, and a fluid drain. APD machines pump fresh dialysatefrom a dialysate source, through the catheter, into the patient'speritoneal cavity. APD machines allow the dialysate to dwell within thecavity, thereby enabling the transfer of waste, toxins and excess waterto take place. The source can be multiple sterile dialysate solutionbags. APD machines pump spent dialysate from the peritoneal cavity,though the catheter, to the drain. As with the manual process, severaldrain, fill and dwell cycles occur during APD. A “last fill” occurs atthe end of CAPD and APD, which remains in the peritoneal cavity of thepatient until the next treatment.

CCPD treatments attempt to drain the patient fully upon each drain. CCPDand/or APD may be batch type systems that send spent dialysis fluid to adrain. Tidal flow systems are modified batch systems. With tidal flow,instead of removing all of the fluid from the patient over a longerperiod of time, a portion of the fluid is removed and replaced aftersmaller increments of time.

Peritoneal dialysis dialysate may include a solution or mixture thatincludes between 0.5% and 10% dextrose (or more generally glucose),preferably between 1.5% and 4.25%. Peritoneal dialysis dialysate mayinclude, for example, Dianeal®, Physioneal®, Nutrineal®, and Extraneal®dialysates marketed by the assignee of the present disclosure. Thedialysate may additionally or alternatively include a percentage oficodextrin. It should be appreciated that in some embodiments of thepresent disclosure, the dialysate may be infused into the patient 110via the infusion pump 102 rather than the RFT machine 104.

Continuous flow, or CFPD, dialysis systems clean or regenerate spentdialysate instead of discarding it. CFPD systems pump fluid into and outof the patient, through a loop. Dialysate flows into the peritonealcavity through one catheter lumen and out another catheter lumen. Thefluid exiting the patient passes through a reconstitution device thatremoves waste from the dialysate, e.g., via a urea removal column thatemploys urease to enzymatically convert urea into ammonia (e.g. ammoniumcation). The ammonia is then removed from the dialysate by adsorptionprior to reintroduction of the dialysate into the peritoneal cavity.Additional sensors are employed to monitor the removal of ammonia. CFPDsystems are typically more complicated than batch systems.

In both hemodialysis and peritoneal dialysis, “sorbent” technology canbe used to remove uremic toxins from waste dialysate, re-injecttherapeutic agents (such as ions and/or glucose) into the treated fluid,and reuse that fluid to continue the dialysis of the patient. Onecommonly used sorbent is made from zirconium phosphate, which is used toremove ammonia generated from the hydrolysis of urea. Typically, a largequantity of sorbent is necessary to remove the ammonia generated duringdialysis treatments.

Similar to the infusion pump 102, the RFT machine 104 may be programmedlocally with a dialysis prescription or receive a dialysis prescriptionvia the RFT gateway 114. The RFT machine 104 is configured to perform arenal failure therapy on the patient 110, which, as discussed above,includes removing ultrafiltration from the patient 110. With peritonealdialysis, the RFT machine 104 infuses dialysate into the patient 110during the fill cycles. For any dialysis prescription, the RFT machine104 may compare parameters of the prescription to one or more limits andprovide any alerts or alarms if a parameter of the prescription violatesa soft or hard limit. The RFT machine 104 is configured to monitor theprogress of the therapy and periodically transmit renal failure therapyprogress data 140 to the RFT gateway 114. The renal failure therapyprogress data 140 may include, for example, a fill rate, a dwell time, adrain or fluid removal rate, a blood flow rate, effluent dose, anultrafiltration removal rate, a dialysate removal rate, a totaldialysate infused, dialysate flow, replacement pre-flow, replacementpost-flow, patient weight balance, return pressure, excess patient fluidsign, filtration fraction, a time remaining, dialysate concentration,dialysate name, a patient identifier, a room identifier, a care areaidentifier, a timestamp when the data was generated, an alarm condition,an alert condition, an event, etc. The RFT machine 104 may transmit thedata continuously, periodically (e.g., every 30 seconds, 1 minutes,etc.), or upon request by the RFT gateway 114.

The RFT gateway 114 includes a server, processor, computer, etc.configured to communicate with the RFT machine 104. The RFT gateway 114may include, for example, the Global Baxter Exchange™ (“GBX”) server orgateway. The gateway 114 may be communicatively coupled to more than oneRFT machine. The RFT gateway 114 is configured to provide bi-directionalcommunication with the machine 104 for the wired/wireless securetransfer of drug libraries, dialysis prescriptions, and renal failuretherapy progress data 140. The gateway 114 may also be configured tointegrate with or communicate with the HIS 120 or other hospital systemto transmit the renal failure therapy progress data 140 from the RFTmachine 104 to a patient's EMR. The renal failure therapy progress data140 may also be used by the HIS 120 for analytics, reporting, and/orconsulting.

The example patient monitor 106 of the illustrated embodiment of FIG. 1is configured to display one or more graphs of physiological data 107from the physiological sensor 108. The monitor 106 may be wired orwirelessly coupled to the sensor 108, which may include, for example, aheart rate sensor (e.g., an EKG sensor, an ECG sensor), a temperaturesensor, a pulse oximetry sensor, a patient weight scale, a glucosesensor, a respiratory sensor, a blood pressure sensor, etc. The patientmonitor 106 is configured to display the data from the sensors within atime-based graph. The patient monitor 106 may also display a numericalvalue of the most recent data from the sensor 108 in addition to colorcoding the data. Collectively, the data received at the patient monitor106 from the sensors 108 may be referred to herein as physiological data150.

The patient monitor 106 is communicatively coupled to the monitorgateway 116. The patient monitor 106 may continuously, periodically, orupon request, transmit the physiological data 150 to the monitor gateway116, which may then transmit the physiological data 150 to the HIS 120for inclusion in the patient's EMR or within a clinician's records. Thephysiological data 150 may also be used with the data 130 and 140 withina CQI system or transmitted to the clinician device 124.

The example monitor gateway 116 of FIG. 1 includes an integration engine160 configured to process the data 130, 140, and 150 respectively fromthe infusion pump 102, the RFT machine 104, and the patient monitor 106.The example integration engine 160 is configured to analyze the data130, 140, and 150 in conjunction with one or more routines, algorithms,etc. to determine how the data is to be displayed and/or presented. Forinstance, while the patient monitor 106 is configured to display thephysiological data 150 from connected sensors 108, the patient monitor106 may not be configured to display the data 130 and 140. In someembodiments, the data 130 and 140 may be in a standard or format that isnot compatible or recognized by the patient monitor 106

The integration engine 160 is configured to convert or otherwise formatthe data 130 and 140 into a standard, format, or protocol that iscompatible with the monitor 106 (e.g., referred to herein as a commonformat). The integration engine 160 is also configured to determinewhich of the infusion data 130 and dialysis data 140 is to be displayedat a particular time and instruct the monitor 106 to display theconverted or formatted data in conjunction with the physiological data150 at the specified time. The result is the concurrent display ofinfusion data and renal failure therapy data with physiological datafrom the same time. Such a configuration enables a clinician to view inone location infusion data, renal failure therapy data, andphysiological data, and be able to quickly determine how a change to therenal failure therapy or infusion affects a patient's physiologicalcondition.

The concurrent processing, integration, and conversion of the data 130,140 and/or 150 enables the integration engine 160 to also determineconditions, deltas, or derivatives based on the different types of data.For example, the integration engine 160 may include a routine thatcompares an amount of fluid infused into a patient to fluid removed fromthe patient through dialysis or a renal failure therapy to determinederivative data indicative of fluid balance. The integration engine 160may then calculate a new fluid difference and provide this informationto the monitor 106 for concurrent viewing with the infusion and renalfailure therapy data 140.

Such a configuration also enables the integration engine 160 to provideenhanced alerts and/or alarms. For example, the integration engine 160may be configured to operate a routine that compares the patient'sphysiological parameters to hard limits, soft limits, or delta limits.The integration engine 160 may also analyze the therapy progress data130 and/or renal failure therapy data 140 in conjunction with one ormore limits. In one example, the integration engine 160 may detect thata patient's physiological parameters are trending to a dangerous leveland activate an alarm to change (or stop) the infusion therapy or renalfailure therapy. In another example, the integration engine 160 maydetect that a physiological condition is approaching a first limit.However, the integration engine 160 also determines that an infusion isoccurring and that a second higher limit should be used instead.

It should be appreciated that having access to different types of data130, 140, and 150 enables the integration engine 160 to providecountless improvements for interoperability and patient care. Theintegration engine 160 may be configured to dynamically adjust medicaldevice operational limits and/or alarm/alert thresholds based on certainof the data 130, 140, and 150 (and/or derivatives thereof). Forinstance, the infusion pump 102 typically includes one or more druglibraries that define operational parameter limits based on patientweight, gender, care area, etc. The use of the integration engine 160enables at least one of the limits to be specified by routines oralgorithms based on certain data. For example, an infusion dosage limitmay be adjusted based on a type of renal failure therapy being providedconcurrently. In other examples, the integration engine 160 may adjustprescription settings based on analysis of the data 130, 140, and/or 150(and derivatives thereof). For instance, an infusion rate may bedecreased (according to a specified routine) if renal failure therapyprogress data 140 indicatives that the patient 110 is accumulating toomuch fluid. To change a limit or operational parameter, the integrationengine 160 may be configured to create instructions in a messagestandard appropriate for the infusion pump 102 to cause the limits oroperational parameters to be adjusted.

The example integration engine 160 may also facilitate the use of alarmsand/or alerts with dynamic triggering conditions and/or thresholds. Forinstance, the integration engine may analyze the data 130, 140, and/or150 (and derivatives thereof) to determine if certain thresholds foralarms/alerts of the infusion pump 102 and/or the RFT machine 104 are tobe adjusted. Responsive to detecting that a threshold is to be changed,the integration engine 160 transmits one or more messages to theappropriate device 102 or 104 indicative of the threshold modification.The integration engine 160 is configured to use one or more algorithmsand/or routines to determine how combinations of the data 130, 140,and/or 150 (and derivatives thereof) affect alarm/alert thresholds.

The example integration engine 160 may also be configured to generateits own alerts and/or alarms based on the data 130, 140, and/or 150 (andderivatives thereof). The integration engine 160 may include a list ortable of alarms/alerts and corresponding threshold conditions. Theintegration engine compares the appropriate data 130, 140, and/or 150(and derivatives thereof) to the lists to determine if an alarm or alertis to be generated. The table may also specify a destination to wherethe alarm/alert is to be transmitted. For instance, alarms/alerts may betransmitted for display or audio actuation on the infusion pump 102, theRFT machine 104, and/or the patient monitor 106. Additionally oralternatively, the integration engine 160 may transmit alarms/alerts tothe HIS 120 or other medical systems 122. Such a configuration enables,for example, alarms or alerts to be generated based on combinations ofthe therapy progress data 130, the renal failure therapy progress data140, the physiological data 150, and/or derivatives thereof. Forexample, the integration engine 160 may generate an alarm when a fluidbalance (which is derived from infusion and RFT data) exceeds athreshold. Further, the integration engine 160 may be configured toadjust conditions and/or thresholds for the alarms/limits.

In some instances, the integration engine 160 may provide programminginstructions in combination with (or in response to) the alarms and/oralerts. For example, the integration engine 160 may determine an issuewith the infusion pump 102 (or receive an alarm from the infusion pump102) and determine, using a routine to analyze the data, that the RFTmachine 104 is to be suspended. The integration engine 160 accordinglytransmits one or more messages, in a standard appropriate for the RFTmachine 104, to the RFT machine 104, causing the RFT machine 104 tosuspend operation.

In some embodiments, the integration engine 160 may be included within acomputer, processor, and/or server that is communicatively coupled tothe monitor gateway 116. Alternatively, the integration engine 160 maybe distributed among a computer, the monitor gateway 116, and thepatient monitor 106. Such configurations enable a clinician to modify orselect (from a computer or smartphone) which data is to be displayed andwhich routines are to be used for processing the data 130, 140, and 150.The selection by the clinician may update how the monitor gateway 116routes and/or processes the data and/or how the patient monitor 106processes data. Such a configuration also enables user interfacefunctionality to be included in conjunction with the data. This mayinclude providing a clinician the ability to select a net amount offluid waveform or to see individual waveforms of the data 130, 140, and150 that contribute to the determined amount.

In some embodiments, the infusion pump 102 and/or the RFT machine 104may also be communicatively coupled to one or more physiological sensors108. For example, the infusion pump 102 may be connected to a pulseoximetry sensor. The infusion pump 102 may be configured to integrate orotherwise include data from the pulse oximetry sensor into the infusiontherapy progress data 130 or, alternatively, transmit the pulse oximetrydata separately to the infusion gateway 112. Similarly, the RFT machine104 may be communicatively coupled to a blood pressure sensor, a patientweight scale, a glucose sensor, a cardiac monitor, etc. The RFT machine104 may be configured to integrate or otherwise include data from thesensors into the renal failure therapy progress data 140 or,alternatively, transmit the sensor data separately to the RFT gateway114.

Example Embodiment

It should be appreciated that monitoring a patient's fluid balance isimportant to prevent dehydration or overhydration. However, known fluidbalance recording systems are notorious for being inadequate orinaccurate because these systems require separate collection and inputof infusion and renal failure therapy information. However, a clinicianmay not timely record renal failure therapy or infusion information ormay record one but not the other. In some instances, the clinician mayspend some time recording the infusion information and then the renalfailure therapy information. However, the difference in time betweencollecting the infusion and renal failure therapy information mayproduce correlation errors.

In the example hospital environment 100 of FIG. 1, the infusion pump 102is pumping or infusing fluid into the patient 110, while the RFT machine104 removes fluid 105 from the patient 110. The RFT machine 104 may alsobe filling the patient 110 with fluid. In an example, the infusion pump102 may infuse one or more medications or saline, while the RFT machine104 is configured to perform hemodialysis or peritoneal dialysis. Such aconfiguration may be used for certain medications that need to beremoved quickly after being infused or in situations where medicationsare administered to patients with kidney failure.

The fluid ‘ins and outs’ are a key aspect of determining and managing apatient's fluid and hemodynamic status. Before treatment begins, thegateways 112, 114, and 116 are configured to route and process data sothat all data related to the patient 110 is aggregated such that atleast some of the aggregated data may be integrated and/or processed anddisplayed. In this instance, the patient monitor 106 may receive orotherwise obtain an identifier of the patient 110. For instance, a barcode scanner attached to the monitor 106 may be used to scan a wristbandof the patient 110. The monitor 106 may then transmit the identifier inaddition to an IP address or MAC address of the monitor 106 to thegateway 116, where the integration engine 160 correlates the address ofthe monitor 106 with the patient identifier.

Also before treatment, the infusion pump 102 and the RFT machine 104 mayobtain or otherwise receive an identifier of the patient. For instance,a bar code scanner built into the infusion pump or communicativelycoupled to the infusion pump may scan the patient's wristband or amedication container to obtain the patient's identifier. The infusionpump 102 and the RFT machine 104 include the patient's identifier withinthe data 130 and 140.

During treatment, the infusion pump 102 generates the infusion therapyprogress data 130, which is transmitted to the gateway 112, while andthe RFT machine generates the renal failure therapy progress data 140,which is transmitted to the gateway 114. The example gateways 112 and114 transmit the respective data to the monitor gateway 116. The examplepatient monitor 106 also transmits the physiological data 150 (includingthe patient identifier) to the monitor gateway 106. The integrationengine 160 at the monitor gateway 106 analyzes the data 130 and 140 forthe patient identifier. All of the data with the same patient identifieris then processed by the integration engine 160 for display at thepatient monitor 106. For instance, the integration engine 160 may searchall of the data associated with the same patient for timestampinformation. The integration engine 160 may then send the data with thesame timestamps to the patient monitor 106 for display within respectivecharts.

The example integration engine 160 may also calculate or process thedata 130, 140, and 150 for specific derivative values or parameters. Forinstance, the integration engine 160 may use a rate of infusion from theinfusion pump 102 and a dialysis fluid removal rate from the RFT machine104 to determine a net fluid accumulation in the patient 110. Theintegration engine 160 may then attach a timestamp to the net fluidaccumulation data corresponding to the timestamp of the rate of infusionand the dialysis fluid removal rate. The integration engine 160 thensends the net fluid accumulation data, the rate of infusion, and thedialysis fluid removal rate to the monitor 106 for display.

FIG. 4 shows a diagram of the patient monitor 106 displaying data fromthe integration engine 160, according to an example embodiment of thepresent disclosure. A user interface 402 is configured to displayphysiological sensor data 150 including, for example, EKG data,respiratory data, pulse oximetry data, and blood pressure data. Inconjunction with the most recent value, the user interface 402 displaysa timeline or chart of each data type. It should be appreciated that thetimeline scale for each data type may be the same, but could bedifferent based on user selections.

The user interface 402 also shows a numerical value illustrating anamount of fluid per time period (cc/hour) actively being infused intothe patient 110 via the infusion pump 102. The integration engine 160may combine data from all infusion pumps 102 connected to the patient110 and/or data from the RFT machine 104. The integration engine 160 mayfurther combine fluid input from other devices such as, for example,nutritional feeding tubes. The data is displayed as a waveform of inputrate over recent time in addition to a numerical value showing a totalfluid infused over some configurable recent time period (e.g., last 8hours).

The user interface 402 further shows a numerical value illustrating anamount of fluid per time period (cc/hour) actively being removed fromthe patient 110 via the RFT machine 104. The integration engine 160 maycombine data from all RFT machines 104 connected to the patient 110and/or data from a urine collection device (e.g., the physiologicalsensor 108). The data is displayed as a waveform of output rate overrecent time in addition to a numerical value showing a total fluidremoved over some configurable recent time period (e.g., last 8 hours).

The example user interface 402 moreover shows a numerical valueillustrating the net amount of fluid change per time period (e.g.,cc/hour). This derivative data is displayed as a waveform of net rateover recent time in addition to a numerical value showing a net fluidchange over some configurable recent time period (e.g., last 8 hours).

The example integration engine 160 may also be configured to sendinstructions to the monitor 106 regarding which data is to be displayed.For example, the integration engine 160 may only receive the data 130from the infusion pump 102. In response, the integration engine 160 maysend an instruction to the monitor 106 indicating that only a timelineor waveform for infusion rate is to be displayed.

As discussed above, more than one infusion pump 102 may be connected tothe patient 110. In these circumstances, the integration engine 160 mayaggregate (according to a predefined routine) the fluid input to thepatient based on the data 130 from all of the pumps. In addition, theintegration engine 160 may be configured to create a list or datastructure of the names of the substances being infused into the patient.The integration engine 160 may order the names of the various substancesand send the order to the monitor 106 for display within user interface402. The integration engine 106 may order the names based on importance,criticality to the patient, infusion rate, etc. In instances where thenumber of names is greater than a display area within the user interface402, the example integration engine 160 may specify which names are tobe displayed and which names are to be hidden behind an ellipsis. Theintegration engine 160 may set the ellipsis as an input field, suchthat, selection by the user causes the monitor 106 to display the othernames, or causes the integration engine 160 to send the other names.

The integration engine 160 may also determine which infusions are activecompared to infusions that are paused or finished (based on statusindicators or infusion rate information specified within the infusiontherapy progress data 130). The integration engine 160 may order theinfusion names based on activity and/or may color code the names basedon activity. In some instances, the integration engine 160 may cause themonitor 106 to display, adjacent to the net amount of fluid waveform, anindication of the active infusions.

In some instances, each of the names may also be set as an input field.Selection of a particular name may cause the integration engine 160 todisplay fluid input to the patient for only that selected substance. Theintegration engine 160 may also determine for display a net amount offluid between the selected infusion substance the dialysis data. Theintegration engine 160 may be configured to perform this net amount offluid input for multiple selections of infusion substances that comprisea subset of the entire set of known infusion substances.

It should be appreciated that the integration engine 160 may include alimitless number of routines specifying how the data 130, 140, and 150(and derivatives thereof) is to be processed and configured for display.Some of the routines may be predefined based on defined relationshipsbetween the data. Other ones of the routines may be specified by anoperator at the monitor 106. For example, a clinician may select whichdata types are to be displayed at the monitor 106. The selection ofcertain data types may cause the integration engine 160 to execute aroutine to determine the selected data type.

The example integration engine 160 also is configured to ensure that thedata 130 and 140 is in a format acceptable for display by the patientmonitor 106. The engine 160 may perform this conversion upon receivingthe data. For instance, the integration engine 160 may include aplurality of well defined application programming interfaces (“APIs”)configured to accept data from the respective devices 102 and 104. TheAPIs may define how fields or packet structure is to be converted and/orparsed for analysis and routed to corresponding fields or packetscompatible with the monitor 106.

Hospital Environment Additional Embodiments

FIGS. 5 to 9 show diagrams of the hospital environment 100 of FIG. 1with the integration engine 160 operating at different devices,according to example embodiments of the present disclosure. Forinstance, FIG. 5 shows the integration engine 160 included within thepatient monitor 106. In this instance, the patient monitor 106 providesthe physiological data 150 to the integration engine 160 withouttransmission to another device. The patient monitor 106 may still sendthe physiological data 150 to the monitor gateway 116 for inclusionwithin, for example, an EMR. The use of the integration engine 160 atthe patient monitor 106 may provide relatively faster responses to auser's input and/or may make customization of routines at the patientbedside easier. For instance, a clinician may use the user interface 402of the patient monitor to select which data is to be displayed insteadof having to connect or access the monitor gateway 116 to make theselection.

FIGS. 6 and 7 illustrate that the integration engine 160 may be includedat the RFT gateway 114 and/or the RFT machine 104. In these instances,the scanning of the patient's identifier at the RFT machine 104 causesthe RFT machine 104 and/or the RFT gateway 114 to broadcast to themonitor gateway 116 and the infusion gateway 112 that data including thepatient identifier is to be routed to the RFT gateway 114.Alternatively, the scanning of the patient identifier at the RFT machine104 causes the RFT machine 104 and/or the RFT gateway 114 to subscribeat the infusion gateway 112 to the data 130 related to the patientidentifier and subscribe at the monitor gateway 116 to the data 150related to the patient identifier. The subscription to the data causesthe infusion gateway 112 and the monitor gateway 116 to transmit thedata 130 and 150 that includes the patient identifier to the RFT gateway114 for display at the RFT machine 104. In this instance, theintegration engine 160 is configured to convert the data 130 and 150into a format that is compatible with the RFT machine 104. Such aconfiguration may be desired when, for example, only a RFT machine andan infusion pump are connected to the patient 110. It should also beappreciated that such a configuration eliminates the need for thepatient monitor 106 if the sensors 108 may be communicatively coupled tothe RFT machine 104 and/or the infusion pump 102.

FIGS. 8 and 9 illustrate that the integration engine 160 may be includedat the infusion gateway 112 and/or the infusion pump 102. In theseinstances, the scanning of the patient's identifier at the infusion pump102 causes the infusion pump 102 and/or the infusion gateway 112 tobroadcast to the monitor gateway 116 and the RFT gateway 114 that dataincluding the patient identifier is to be routed to the infusion gateway112. Alternatively, the scanning of the patient identifier at theinfusion pump 102 causes the infusion pump 102 and/or the infusiongateway 112 to subscribe at the RFT gateway 114 to the data 140 relatedto the patient identifier and subscribe at the monitor gateway 116 tothe data 150 related to the patient identifier. The subscription to thedata causes the RFT gateway 114 and the monitor gateway 116 to transmitthe data 140 and 150 that includes the patient identifier to theinfusion gateway 112 for display at the infusion pump 102. Theintegration engine 160 is configured to convert the data 140 and 150into a format that is compatible with the infusion pump 102. Again, sucha configuration may be desired when, for example, only a RFT machine andan infusion pump are connected to the patient 110. This configurationmay eliminate the need for the patient monitor 106 if the sensors 108may be communicatively coupled to the RFT machine 104 and/or theinfusion pump 102.

Integration Engine Embodiment

FIG. 10 shows a diagram of the example integration engine 160 of FIGS. 1and 5 to 9, according to example embodiments of the present disclosure.As discussed above, the integration engine 160 may be included withinany one of the medical devices 102, 104, and 106 and/or any one of thegateways 112, 114, and 116. Further, the integration engine 160 may bedistributed across more than one device and/or implemented on otherdevices, such as a server. It should be appreciated that the integrationengine 160 described in conjunction with FIG. 10 is only one embodimentand that other embodiments may include fewer or additional components.

The components shown in FIG. 10 may be implemented as separateapplication specific integrated circuits, implemented within one or moreapplication specific integration circuits, and/or defined ascomputer-readable instructions, which when executed cause circuitryand/or a processor to perform one or more specially configuredoperations related to the reception, aggregation, integration,conversion, and/or processing of the data 130, 140, and 150 (andderivatives thereof) for display in a single user interface.

The example integration engine 160 includes an infusion pump interface1002 to receive the infusion therapy progress data 130, a dialysisinterface 1004 to receive the renal failure therapy progress data 140,and a monitor interface 1006 to receive the physiological data 150. Theinterfaces 1002, 1004, and 1006 may include well-defined APIs configuredto receive the data according to a defined format. Alternatively, theinterfaces 1002, 1004, and/or 1006 may include web interfaces toreceive, for example, the data 130, 140, and 150 via packets over anHTTP protocol.

The integration engine 160 may include multiple versions of each of theinterfaces 1002, 1004, and/or 1006 (e.g., different APIs) forcompatibility with different data standards, protocols, formats, etc.For instance, the integration engine 160 may include a first infusionpump interface 1002 to receive infusion data associated with a firststandard and a second infusion pump interface 1002 to receive infusiondata associated with a second standard. The infusion gateway 112, forexample, may have well-defined ports and/or interfaces associated witheach standard that are communicatively coupled to the respectiveinfusion pump interface 1002 at the integration engine 160. Such aconfiguration automatically routes infusion therapy progress data 130 ofeach standard to the appropriate infusion pump interface 1002. It shouldbe appreciated that the gateways 114 and 116 may be similarly configuredas the infusion gateway 112.

Additionally or alternatively, the integration engine 160 may include arouter configured to route the infusion therapy progress data 130 to theappropriate version of the infusion pump interface 1002. For instance, arouter may compare data packet headers, identifiers, or other indicia(e.g., data types, labels, etc.) indicative of the standard to one ormore routing tables. A routing table specifies to which of theinterfaces 1002 the data 130 is to be routed based on determinedstandard. Responsive to determining the standard, the router transmitsthe data to the appropriate infusion pump interface 1002 for conversioninto a common format. It should be appreciated that routers may alsoexist for the interfaces 1004 and 1006.

The data 130, 140, and 150 received at the interfaces 1002, 1004, and/or1006 may be streamed or transmitted periodically from the respectivegateways 112, 114, and 116 and/or the medical devices 102, 104, and 106.In some instances, the interfaces 1002, 1004, and 1006 may be configuredto request the data 130, 140, and 150 from the respective gateways 112,114, and 116 and/or the medical devices 102, 104, and 106. In theseinstances, the request may include the patient identifier and/or anindication of which types of data are to be received.

To receive the data 130, 140, and 150, the example integration engine160 includes a subscriber 1007. The example subscriber 1007 isconfigured to receive an indication as to which patient is locatedadjacent to which medical devices. For instance, if the integrationengine 160 is located at the monitor gateway 116, the patient monitor106 may provide a patient identifier as well as a MAC address or IPaddress. The IP or MAC address is used by the integration engine 160 asa destination address for packets or data that is transmitted fordisplay. The subscriber 1007 is configured to transmit the patientidentifier to the gateways 112 and 114 (in instances where the engine160 is at the gateway 116) to subscribe to the data 130 and 140 thatincludes the patient identifier. Subscribing causes the gateways 112 and114 to transmit any of the data 130 and 140 with the specified criteriato the integration engine 160.

Alternatively, the gateway 116 (and the integration engine 160) mayreceive all the data from the gateways 112 and 114. In this instance,the subscriber 1007 operates with the interfaces 1002, 1004, 1006,converter 1008, and/or data integrator 1010 to select which of the datais to be processed and/or displayed. In some of these instances, thesubscriber 1007 may provide the patient identifier to the monitorgateway 116, which filters by patient identifier and transmits thefiltered data to the interfaces 1002, 1004, and 1006.

The subscriber 1007 may also subscribe to certain data types in additionto data related to a patient. For example, configuration or setup at themonitor 106 may include specifying that all infusion rate data is to bedisplayed. The integration engine 160 receives this configurationinformation via configurer 1012, which is transmitted to the subscriber1007. The example subscriber 1007 determines one or more parameters,data labels, and/or corresponding data identifiers associated withinfusion rate and transmits one or more subscription messages to theinfusion gateway 112, including the patient identifier and identifiersof the desired parameter (e.g., infusion rate, drug name, pumpidentifier, etc.). This causes the infusion gateway 112 to only send therelevant data that includes the specified parameters or identifiers,thereby reducing the amount of data transmitted through the hospitalenvironment 100 and processed by the integration engine 160.

The example subscriber 1007 is dynamic. For instance, during atreatment, a clinician at the monitor 106 may specify to also viewinfusion dose. This causes a message to be sent from the monitor 106 tothe integration engine 160 (via configurer 1012), which determines (viathe subscriber 1007) one or more infusion parameters (and correspondingidentifier(s)) associated with infusion dose data. The subscriber 1007then sends a subscription message to the infusion gateway 112 with theidentifiers of the desired dose data.

The example integration engine 160 of FIG. 10 also includes a converter1008 configured to format or otherwise convert the received data 130,140, and 150 into a form that is compatible with the device that is todisplay the data (e.g., the patient monitor 106). The converter 1008 mayinclude separate modules or interfaces for receiving data of differentstandards from respective versions of the interfaces 1002, 1004, and1006. Conversion at each module may be conducted according to aspecified routine for converting data from one standard into anormalized or common standard. For example, a module for a firststandard may have definitions that relate labels of the first standardto labels for a common standard. The module uses this one-to-one ormany-to-one mapping to determine how the data is to be converted.

Alternatively, the integration engine 160 may include one of each typeof interface 1002, 1004, 1006. In these alternative embodiments, theconverter 1008 is configured to determine a standard for the receiveddata 130, 140, and 150. The converter 1008 then routes the received datafor each standard to the appropriate data conversion algorithm orengine. For instance, the converter 1008 may include one or more welldefined conversion algorithms that specify how data of certain formatsor standards, or located in certain portions of a packet are to beparsed and reformatted for analysis. For example, the algorithms mayinclude a look-up table of parameter names, labels, and/or data typesrelated to different known medical devices to enable the converter 1008to determine the contents of the data. It should be appreciated that thelook-up table (or algorithms) may provide a conversion for each standardof supported data. Further, the look-up table (or algorithms) may beupdated periodically as additional standards are created or differenttypes of medical devices are added to the environment 100.

The example data integrator 1010 of FIG. 10 is configured to analyze thedata from the different interfaces 1002, 1004, and 1006 (and derivativedata thereof) and determine which data is to be displayed concurrently.The data integrator 1010 may access a database 1014 (e.g., a memory)that provides criteria as to which data is to be displayed. This isespecially true in instances where the integration engine 160 receivesall the data 130, 140, and 150 for a particular patient. In instanceswhere only, certain data is subscribed to, the example data integrator1010 still has to determine which data is from the same time period.

In an example embodiment, the data integrator 1010 may receive aninstruction that data for a particular patient is to be processed fordisplay. The data integrator 1010 accesses the database 1014 for a listof data types, parameters, or data identifiers that are to be displayed.The data integrator 1010 then parses or otherwise filters data for theparticular patient that includes the specified identifiers. The dataintegrator 1010 also reads timestamps associated with the data to ensuredata from the same time period or time frame is later processeddownstream at the same time for concurrent display. In some instances,the data integrator 1010 may aggregate selected data for the same timeperiod into one or more packets having the same timestamp.

The example configurer 1012 of FIG. 10 is configured to define listsregarding which data is to be displayed at, for example, the monitor106. The example configurer 1012 may provide an interface or operatethrough the user interface 402 of the patient monitor 106. Theconfigurer 1012 may include a list of available parameters or data typesthat may be displayed. The list may also include identifiers of allmedical devices and sensors related to the patient. The configurer 1012may dynamically update the list as additional devices are connected toor otherwise associated with the patient 110.

In one embodiment, a clinician may configure the monitor 106 before atreatment begins. In this instance, the configurer 1012 may provide adefault list of parameters for the clinician to select. The configurer1012 may then determine the specific device parameters or device itselfas the device comes online and begins transmitting data. In thisinstance, the configurer 1012 enables the clinician to select whichwaveforms are to be displayed and then operates with the subscriber 1007and the data integrator 1010 to ensure that the desired data isdisplayed. If for example, data is not available, the integration engine160 may provide an error message or a null waveform (e.g., a clinicianselects to view an ultrafiltration rate of a RFT when in fact no RFT ordialysis machine is connected to the patient 110).

In another embodiment, the configurer 1012 may track which devices areassociated with a patient identifier. The configurer 1012 may determineparameters or data types of each device and construct a correspondinglist for the clinician to configure the monitor 106. For instance, eachmedical device may transmit a device identifier in conjunction with thepatient identifier upon being associated with the patient. Theconfigurer 1012 receives the message and uses the device identifiers totrack which devices are connected to or otherwise related to the patient110.

The configurer 1012 also enables a clinician or an administrator tocreate one or more routines or algorithms for processing and/or creatingderivatives of the data 130, 140, and 150. For instance, anadministrator or a clinician may use the configurer 1012 to define acalculation for total fluid input based on which devices are connectedto the patient. The configurer 1012 may provide a graphical programmableinterface that, for example, shows a map or illustration of the devicesassociated with a patient and the corresponding parameters. Theclinician may drag or otherwise select the parameters associated withfluid input from the different machines into an equation, which createsa routine stored to the database 1014. A processor 1016 accesses theroutine at the database 1014 to determine which and how the parametersare to be summed.

In other instances, the database 1014 may store default calculations orroutines to determine commonly used derivatives of the data 130, 140,and 150. For example, a default calculation for fluid balance mayspecify that infusion rate data 130 is needed in addition to fluid filland output data 140 and urine data 150. Selection of the fluid balancecalculation may cause the configurer 1012 to determine that the infusionrate data 130 is needed in addition to fluid fill and output data 140and urine data 150 for display and ensure that the appropriate devicesare programmed and connected to the patient 110. During patienttreatment, the processor 1016 determines the values for fluid balancebased on the calculation using the infusion rate data 130 in addition tofluid fill and output data 140 and urine data 150, and provides thesecalculated derivative values for display.

Alternatively, an administrator may define default routines before anypatient treatments. The configurer 1012 may populate the routines basedon which devices are connected to the patient and/or preferences of aclinician. For example, an administrator may create via the configurer1012 a default definition of fluid intake, which may specify that aninfusion rate from all infusion pumps connected to a patient are summedwith dialysis fluid provided into a patient's peritoneal cavity inaddition to any information received from a nutritional feeding system.The configurer 1012 may receive a message from the monitor that aclinician desires to view the fluid intake parameter, which causes theconfigurer 1012 to determine (if already not completed) which infusionpumps, RFT machines, and nutritional feeding systems are connected tothe patient. The configurer 1012 then searches for the infusion rate,dialysis rate, and feeding rate parameters from those machines andpopulates the routine accordingly.

The example processor 1016 of FIG. 1 is configured to determine anyparameters or derivatives of the data 130, 140, and 150 based on one ormore routines and/or algorithms stored within the database 1014. Theexample processor 1016 for example, uses one or more routines todetermine total fluid input to a patient, total fluid output from apatient, and net total fluid within the patient. The processor 1016performs the one or more routines for every instance or timestamp of theconverted and integrated data 130, 140, and 150.

The example processor 1016 may also operate with the configurer 1012 toprovide user interface functionality with the data. For instance, theprocessor 1016 may define one or more actions that may be performedcontingent upon a user selecting a portion of a waveform displayed atthe monitor 106. Specifically, the processor 1016 may create a menuoption box that is hidden from display until a user selects a waveform.Selection of a menu option may change which data is to be displayed. Theexample processor 1016 and/or the configurer 1012 updates a list withinthe database 1014 with the new selection by the user, which causes thedata integrator 1010 to possibly select additional or less data forprocessing and causes the processor 1016 to perform more or fewerroutines.

The processor 1016 may also operate one or more routines related toalarms, alerts or events. For instance, the processor 1016 may comparespecified data to limits or trends of data to limits to determine if analert or event is to be generated. The processor 1016 may transmit amessage to the monitor 106 causing the alarm or event to be displayed.It should be appreciated that the routines may be complex with theability to take into account data from a wide variety of medicaldevices. For example, certain alarm limits may be adjusted based onwhether an infusion or dialysis is occurring. In another instance, analarm for a limit on the amount of fluid placed into a patient may bedelayed upon determining a RFT machine is about to begin a drain phase.

The example processor 1016 also formats the data for display, includingtransmitting data associated with the same timestamp at the same time(or as close as possible) to the monitor 106. The processor 1016 mayfurther format the data to be compatible with the patient monitor 106.For instance, the processor 1016 may provide indications regarding whichdata is to be displayed at certain screen locations on the monitor 106.The clinician may provide the initial determination, which is includedby the processor 1016 in one or more messages to the monitor 106.Alternatively, the processor 1016 may determine the order based onpredetermined importance of the different parameters or data types.

The example transmission interface 1018 of the integration engine 160 isconfigured to transmit data for display within the user interface 402 ofthe patient monitor 106, for example. The transmission may include datapackets. Alternatively, the transmission may include a stream of data.In some instance, the transmission interface 1018 may transmit the dataperiodically, such as every 5 or 10 seconds. Alternatively, thetransmission interface 1018 may queue the data until a request messageis received from the patient monitor 106.

Based on the above disclosure, it should be appreciated that theintegration engine 160 improves the performance of the hospitalenvironment 100 by simultaneously processing thousands of pieces of data(in different formats) from hundreds or thousands of medical devicessuch that only specified data for a particular patient is displayed on asingle user interface. The integration engine 160 also includes logic,algorithms, or routines to determine parameters, events, or alarms fromthe received data and make these parameters, events, and alarms also fordisplay within the user interface. Such an operation is beyond thecapabilities of a general purpose computer operating general or genericfunctions.

Flowchart of Example Integration Engine Data Processing Embodiment

FIGS. 11 and 12 show a flow diagram illustrating an example procedure1100 to process medical data from different medical devices for displayat a user interface, according to an example embodiment of the presentdisclosure. The example procedure 1100 may be carried out by, forexample, the integration engine 160 described in conjunction with FIGS.1 to 10. Although the procedure 1100 is described with reference to theflow diagram illustrated in FIGS. 11 and 12, it should be appreciatedthat many other methods of performing the functions associated with theprocedure 1100 may be used. For example, the order of many of the blocksmay be changed, certain blocks may be combined with other blocks, andmany of the blocks described are optional.

Procedure 1100 begins when the integration engine 160 receives a message1101 that includes a patient identifier of a patient that is to undergoa treatment (block 1102). The integration engine 160 may also receive anindication as to which medical devices are associated with the patientidentifier. In some instances, the integration engine 160 may query someor all of the gateways 112, 114, and/or 116 to determine which medicaldevices are associated with the patient. In these examples, the medicaldevices may prompt a clinician to enter a patient identifier or scan abarcode associated with the patient prior to programming or beginningtreatment. In these examples, the patient identifier may be includedwithin a header of the medical data. Additionally or alternatively, theintegration engine 160 may query the HIS 120 for the patient-deviceassociation. In these examples, the downstream HIS 120 may make theassociation or determine the association between medical devices andpatients.

The integration engine 160, executing procedure 1100, may also receiveone or more messages 1103 indicative of which medical data is to bedisplayed at a patient monitor (block 1104). The messages 1103 mayspecify a name or identifier of a medical device parameter correspondingto a waveform or numerical value. In some instances, the integrationengine 160 may determine the identifiers as specified by the generatingmedical device based on the parameters or parameter names input at thepatient monitor.

FIG. 13 shows a diagram of an example configuration user interface 1300that may be operated by the integration engine 160 and displayed by thepatient monitor 106, according to an example embodiment of the presentdisclosure. In this example, the integration engine 160 determines whichmedical devices are associated with ABC123 patient. This includesdetecting which medical devices are directly or indirectly connected tothe monitor 106, which may include a heart rate sensor and/or a bloodpressure sensor. Accordingly, the integration engine 160 causes thepatient monitor 106 to display icons indicative of the connectedsensors. A user may select any or each of the sensors, causing theintegration engine 160 to determine information about the sensors (e.g.,identifier, data type(s), data standard, etc.) and whether the sensor isconfigurable. For example, the integration engine 160, through the userinterface 1300, may enable a user to select which types of data isoutput by a sensor and/or how often the data is transmitted.

The example user interface 1300 also displays medical devices that arenot connected to the monitor 106 but which are determined to beassociated with the patient. In the illustrated example, the associatedpatient devices include the SP9CY infusion pump 102 and the WSPEXQperitoneal RFT machine 104. The integration engine 160, through pollingof the devices (or through libraries defining configurations),determines which parameters of medial data are outputted (or selected tobe output based on therapy type of clinician selection) by each device.For instance, the infusion pump is to transmit infusion rate therapyprogress data 130, infusion dose therapy progress data 130, and volumeto be infused (“VTBI”) therapy progress data 130. The integration engine160, through the user interface 1300, enables a clinician to selectwhich of the data is to be displayed on the monitor 106 duringtreatment. In some examples, a clinician may select each of theparameters, causing the integration engine 160 to query the medicaldevice for (or otherwise determine) operation information. Theintegration engine 160, through the user interface 1300, then enables auser to change therapy parameters or settings, which causes theintegration engine 160 to send one or more messages to the appropriatemedical device with the programming instructions. In this manner, theintegration engine 160 enables a clinician to program the medicaldevices connected to or otherwise associated with a patient from onedevice, for example, the monitor 106.

The example user interface 1300 also includes features that enable aclinician to program or configure alarms and/or derivative data. FIG. 14shows a diagram of an example derivative data configuration userinterface 1400 that may be operated by the integration engine 160 anddisplayed by the patient monitor 106, according to an example embodimentof the present disclosure. Selection of the ‘Derivative Data’ icon onthe user interface 1300 may cause the integration engine 160 to displaythe user interface 1400. The integration engine 160, through userinterface 1400, enables a clinician to select derivate data to displayon the monitor 106 and/or to create a new type of derivate data based onmedical device. The user interface 1400 includes a list of medicaldevices related to Patient ABC123, which includes an infusion pump, RFTmachine, heart rate sensor, and blood pressure sensor. The userinterface 1400 also includes a section 1402 that displays which medicaldata is available from the medial devices.

The example user interface 1400 also displays a definition section 1404that is configured to specify how derivate data is derived. In someinstances, the definition may be predefined or pre-specified. Forexample, the user interface 1400 may include a section (not shown) ofavailable types of derivative data based on the available types ofmedical data. To determine the types of available derivate data, theintegration engine 160 may compare the available types of medical datain section 1402 to a list of derivative data that identifies all of thevariables of medial data needed to be available to enable the derivativedata to be determined. In some instances, a clinician may select certainderivative data, and the integration engine 160 may provide anindication as to which medical data is still needed. Such an indicationmay be provided as an instruction or reminder to the clinician aboutadditional devices that need to be connected to or associated with thepatient.

In the illustrated example of FIG. 14, the user interface 1400 withinsection 1404 is configured to enable a clinician to graphically createderivative data. For example, the user interface 1400, via theintegration engine 160, enables a clinician to select and drag medialdata to section 1404, which creates a graphical representation. The userinterface 1400 also enables the clinician to select operations fromsection 1406 to specify a relationship between the data. Such aconfiguration specially programs the integration engine 160 to determinethe derivative data using the routine specified graphically by theclinician. In this example, a clinician specifies how fluid balancederivate data is determined from a combination of infusion therapy data130 and RFT data 140. It should be appreciated that the integrationengine 160 may provide a similar interface to facilitate thespecification of conditions/thresholds for alarms and/or alerts.

Returning to FIG. 11, after data selection and/or configuration, theintegration engine 160 uses the patient identifier and/or the medicaldata to subscribe or otherwise receive or filter the identified medicaldata associated with the identifier patient (block 1106). For example,the integration engine 160 may transmit one or more messages 1107 to theappropriate gateway 112, 114, and/or 116 to receive the selected orrequested medical data 130, 140, and/or 150. The messages 1107 mayinclude an IP address or other address/identifier/port interface numberassociated with the integration engine 160. The messages 1107 may alsoinclude an identifier or data label of the requested medical data.

The integration engine 160 then receives medical data from the medicaldevices (block 1108). The medical data may be received within one ormore messages and/or packets 1109 from, for example, the gateways 112,114, 116, and/or the patient monitor 106. The integration engine 160 maydetermine which of the data is associated with the patient and/oridentified parameters (block 1110). For instance, the integration engine160 may manage medical data processing for hundreds of patients, eachassociated with two or more medical devices outputting at least oneparameter of medical data or therapy progress data. In other words, theintegration engine 160 may subscribe to a significant amount of medicaldata that needs to be organized by patient, medical device, parameter,timestamp, etc. It should be appreciated that this step may be omittedwhen the integration engine 160 is configured to subscribe or receivemedical data related to only one patient.

The integration engine 160 determines which of the identified data is tobe displayed based on the previously received message(s) 1103 at block1104 (block 1112). The integration engine 160 determines if one or moreroutines or algorithms are to be operated to further process the medicaldata to determine derivative data (block 1114). For instance, if theintegration engine 160 determines that total fluid input, total fluidoutput, and net fluid parameters are to be determined and displayed atthe monitor, the integration engine 160 operates the associated routinesfor determining these parameters (block 1116). The integration engine160 may then convert the medical data for display into a format that iscompatible with the patient monitor (block 1118). In some examples, thisstep may instead be performed after the medical data from the medicaldevices is received. The integration engine 160 then transmits themedical data to the patient monitor for display (block 1120). It shouldbe appreciated that blocks 1108 and 1120 may be continuously loopedthrough as long as the patient is undergoing the treatment and/or untilall of the medical devices have been deactivated or dissociated from thepatient. At this point, the example procedure 1100 ends with respect thepatient being monitored.

Data Conversion Embodiment

As discussed above, the example integration engine 160 of FIGS. 1 and 5to 12 is configured to convert or otherwise convert medical data 130 and140 from one standard, format, language, or protocol into anotherstandard, format, language, or protocol that is compatible with the HIS120 or another medical device. FIG. 15 shows a diagram of dataconversion provided by one or more integration engines 160 within theexample hospital environment 100 of FIG. 1, according to exampleembodiments of the present disclosure. In the illustrated example, theinfusion gateway 112 includes a first integration engine 160 a, the RFTgateway 114 includes a second integration engine 160 b, and the patientmonitor 106 includes a third integration engine 160 c (the monitorgateway 116 is omitted). However, in some alternative embodiments, themonitor gateway 116 may be included within the environment 100 andoperate the integration engine 160 c.

In the example of FIG. 15, the infusion pump 102 and the RFT machine 104are configured to operate using the EXTCOM protocol (i.e., a Baxter®proprietary communication protocol). The patient monitor 106 isconfigured to operate using the Health Level 7 (“HL7”) protocol. Inknown hospital systems, the infusion pump 102 and the RFT machine 104would not be capable of communicating with the patient monitor 106because of the use of different protocols.

The EXTCOM protocol uses Extensible Markup Language (“XML”) encodingsyntax that includes a header, body, and session token identifier. Theheader includes fields that specify, for example, an EXTCOM protocolversion, transmitting device serial number, destination address, messagetimestamp, unique message identifier, a type of EXTCOM message, anencryption flag, and an authentication token. The header may alsospecify a device EMR identifier for configuration with, for example, theHIS 120. The message type may include a status message, a configurationmessage, a setup message, a drug library message, a pump query message,or an infusion order message.

The HL7 protocol also includes XML encoding syntax. Some portions of theHL7 protocol include message headers that are similar to the EXTCOMprotocol, including protocol version, transmitting device serial number,destination address, message timestamp, unique message identifier.However, the HL7 protocol uses different labels for the header fieldscompared to the EXTCOM protocol. In addition, the HL7 protocol mayinclude additional header fields including an interaction identifier, aprocessing code, device type identifier, a transmitting device locationidentifier, and a receiving device location identifier.

The RFT machine 104 and the infusion pump 102 are configured to receiveand process EXTCOM messages. This means that the RFT machine 104 and theinfusion pump 102 are programmed to search for header and bodyinformation using certain labels to identify fields. The use ofdifferent labels and message structure make it difficult, if notimpossible for the RFT machine 104 and the infusion pump 102 to receiveand process HL7 messages.

To overcome these limitations, the first integration engine 160 a isconfigured to convert data transmitted to the infusion pump 102 into theEXTCOM protocol. The first integration engine 160 a is also configuredto convert data received from the infusion pump 102 into HL7 protocol.Similarly, the second integration engine 160 b is configured to convertdata transmitted to the RFT machine 104 into the EXCOM protocol. Thesecond integration engine 160 b is also converts data received from theRFT machine 104 into the HL7 protocol. The third integration engine 160c is configured to receive and display data 130 and 140 from therespective medical devices 102 and 104 in the HL7 protocol. In someexamples, the integration engines 160 a and 160 b may be integrated withthe integration engine 160 c at the patient monitor 106 and/or themonitor gateway 116.

In the illustrated example shown in FIG. 15, the infusion pump 102(during treatment of the patient 110) transmits infusion therapyprogress data 130 a formatted in the EXTCOM protocol to the infusiongateway 112. The first integration engine 160 a converts the data 130 afrom the EXTCOM protocol to the HL7 protocol. The first integrationengine 160 a then transmits the converted data 130 b to the patientmonitor 106 for display. To perform the conversion, the firstintegration engine 160 a may include instructions that specify howcertain EXTCOM labels are to be translated into HL7 labels. Theinstructions may also specify the order or placement of the fieldswithin the HL7 message. The instructions may further specify additionalinformation to be added to the HL7 message (if known) or defaultinformation that is to be provided to ensure the HL7 message is verifiedas being proper. In some instances, the instructions may also providefor unit conversion from a first unit type used for EXTCOM to a secondunit type used for HL7. Moreover, the instructions at the integrationengine 160 a may also provide a translation of drug names (orabbreviations) used in the EXTCOM protocol to corresponding drug names(or abbreviations) used in the HL7 protocol.

Also in the illustrated example, the RFT machine 104 transmits renalfailure therapy progress data 140 a that is formatted in the EXTCOMprotocol to the RFT gateway 114. The second integration engine 160 bconverts the data 140 a from the EXTCOM protocol to the HL7 protocol.The second integration engine 160 b then transmits the converted data140 b to the patient monitor 106 for display. The integration engine 160c receives the data 130 b and 140 b in the HL7 format and determineswhether derivative data is to be determined. The integration engine 160c also causes the patient monitor to display the data 130 b and 140 b.In some instances, the integration engine 160 c may be configured toconvert the data 130 b and 140 b into another protocol that iscompatible with the patient monitor 106 before the data can bedisplayed.

Conclusion

It will be appreciated that all of the disclosed methods and proceduresdescribed herein can be implemented using one or more computer programsor components. These components may be provided as a series of computerinstructions on any conventional computer-readable medium, includingRAM, ROM, flash memory, magnetic or optical disks, optical memory, orother storage media. The instructions may be configured to be executedby a processor, which when executing the series of computer instructionsperforms or facilitates the performance of all or part of the disclosedmethods and procedures.

It should be understood that various changes and modifications to theexample embodiments described herein will be apparent to those skilledin the art. Such changes and modifications can be made without departingfrom the spirit and scope of the present subject matter and withoutdiminishing its intended advantages. It is therefore intended that suchchanges and modifications be covered by the appended claims.

It should be appreciated that 35 U.S.C. 112(f) or pre-AIA 35 U.S.C. 112,paragraph 6 is not intended to be invoked unless the terms “means” or“step” are explicitly recited in the claims. Accordingly, the claims arenot meant to be limited to the corresponding structure, material, oractions described in the specification or equivalents thereof.

1. An integration engine apparatus comprising: a configuration interfaceconfigured to receive a patient identifier; a subscription processorconfigured to: transmit a first message, including the patientidentifier, to a first gateway to receive infusion therapy progress datafrom at least one infusion pump, and transmit a second message,including the patient identifier, to a second gateway to receive renalfailure therapy progress data from at least one renal failure therapymachine; and a data processor configured to: cause a first interface toreceive the infusion therapy progress data from the first gateway, causea second interface to receive the renal failure therapy progress datafrom the second gateway, and cause a combination user interface todisplay the infusion therapy progress data within an infusion timelineand the renal failure therapy progress data within a renal failuretherapy timeline that is aligned with the renal failure therapytimeline.
 2. The apparatus of claim 1, wherein causing the firstinterface to receive the infusion therapy progress data includes causingthe first interface to convert the infusion therapy progress data from afirst standard related to the at least one infusion pump to a commonstandard, and wherein causing the second interface to receive the renalfailure therapy progress data includes causing the second interface toconvert the renal failure therapy progress data from a second standardrelated to the at least one renal failure therapy machine.
 3. Theapparatus of claim 1, wherein the data processor is further configuredto: determine derivative data based upon the infusion therapy progressdata and the renal failure therapy progress data; and cause thecombination user interface to display the derivative data within aderivative data timeline that is aligned with the renal failure therapytimeline and the infusion timeline.
 4. The apparatus of claim 3, whereindetermining the derivative data includes: determining a plurality ofdifferent types of derivative data from the infusion therapy progressdata and the renal failure therapy progress data; displaying theplurality of types of derivative data; and receiving a user selection ofone of the plurality of types of derivative data.
 5. The apparatus ofclaim 3, wherein at least one of the configuration interface, thesubscription processor, and the data processor is located at a monitorgateway that is communicatively coupled to the first gateway and thesecond gateway via a network.
 6. The apparatus of claim 5, wherein themonitor gateway is communicatively coupled to a hospital informationsystem server, and wherein the data processor is configured to transmitthe derivative data to the hospital information system server.
 7. Theapparatus of claim 3, wherein the data processor is further configuredto determine the derivative data by: causing the combination userinterface to display a plurality of medical data types and operationsfor selection by an operator; receiving, from the combination userinterface, a selection of at least some of the medical data types and atleast one operation including a relation between the at least some ofthe medical data types and the at least one operation; and defining thederivative data based on the selection of the at least some of themedical data types and the at least one operation.
 8. The apparatus ofclaim 7, wherein the data processor is further configured to determinethe plurality of medical data types for display based on the receivedinfusion therapy progress data and the received renal failure therapyprogress data.
 9. The apparatus of claim 8, wherein the plurality ofmedical data types related to the received infusion therapy progressdata include at least two of an infusion rate, an infusion dosage, andinfusion progress time, an operational status, or a volume of fluidremaining to be infused, wherein the plurality of medical data typesrelated to the received renal failure therapy progress data include atleast two of a fill rate, a dwell time, a drain or fluid removal rate, ablood flow rate, an effluent dose, an ultrafiltration removal rate, adialysate removal rate, a total dialysate infused, a dialysate flowrate, a replacement pre-dilution rate, a replacement post-dilution rate,a patient weight balance, a return pressure, an excess patient fluidsign, a filtration fraction, a time remaining, a dialysateconcentration, or a dialysate name, and wherein the derivative dataincludes fluid balance data, fluid accumulation data, fluid output data.10. The apparatus of claim 7, wherein the operations include at leastone of addition, subtraction, multiplication, division, integration,equation, conditions, a comparison to a data distribution, or acomparison to at least one limit.
 11. The apparatus of claim 3, whereinthe data processor is further configured to determine the derivativedata by: determining a plurality of medical data types based on thereceived infusion therapy progress data and the received renal failuretherapy progress data; determining a plurality of derivative data typesbased on the determined plurality of medical data types; causing thecombination user interface to display the plurality of derivative datatypes; and receiving, from the combination user interface, a selectionof at least one of the plurality of derivative data types.
 12. Theapparatus of claim 1, wherein at least one of the configurationinterface, the subscription processor, or the data processor is locatedat a patient monitor that is communicatively coupled to the firstgateway and the second gateway via a network, the combination userinterface being a user interface of the patient monitor.
 13. Theapparatus of claim 1, wherein the first message causes at least one ofthe subscription processor or the data processor to subscribe to theinfusion therapy progress data based on the patient identifier, and thesecond message causes the subscription processor to subscribe to therenal failure therapy progress data based on the patient identifier. 14.An infusion pump apparatus comprising: a renal failure therapy interfaceconfigured to receive at least one renal failure therapy parameter, apatient identifier, and a renal failure therapy timestamp from a renalfailure therapy machine performing a renal failure therapy treatment fora patient associated with the patient identifier; an infusion treatmentprocessor configured to: perform an infusion treatment for the samepatient concurrently with the renal failure therapy machine, determineat least one infusion parameter related to the infusion treatmentincluding an infusion rate at which fluid is infused into the patient,and determine an infusion timestamp for the at least one infusionparameter; an infusion display engine configured to: determine that theat least one renal failure therapy parameter and the at least oneinfusion parameter are to be displayed at a combination user interfacebased on the patient identifier, determine a difference parameter basedon a difference between the at least one infusion parameter and the atleast one renal failure therapy parameter, display, at the combinationuser interface, the at least one renal failure therapy parameter withina renal failure therapy timeline, display, at the combination userinterface, the at least one infusion parameter within an infusiontimeline that is aligned with the renal failure therapy timeline, anddisplay, at the combination user interface, the difference parameterwithin a difference timeline that is aligned with the renal failuretherapy timeline and the infusion timeline.
 15. The apparatus of claim14, further comprising a display screen communicatively coupled to theinfusion display engine, the display screen configured to display thecombination user interface.
 16. The apparatus of claim 14, wherein therenal failure therapy interface is configured to transmit a message,including the patient identifier, to at least one of the renal failuretherapy machine or a gateway communicatively coupled to the renalfailure therapy machine to receive the at least one renal failuretherapy parameter and the renal failure therapy timestamp.
 17. Theapparatus of claim 14, wherein the message causes the renal failuretherapy interface to subscribe to the least one renal failure therapyparameter based on the patient identifier.
 18. A renal failure therapymachine apparatus comprising: an infusion pump interface configured toreceive at least one infusion parameter, a patient identifier, and aninfusion timestamp from an infusion pump performing an infusiontreatment for a patient associated with the patient identifier; a renalfailure therapy treatment processor configured to: perform a renalfailure therapy treatment for the same patient concurrently with theinfusion machine, determine at least one renal failure therapy parameterrelated to the renal failure therapy treatment including anultrafiltration rate at which fluid is removed from the patient, anddetermine a renal failure therapy timestamp for the at least oneinfusion parameter; a renal failure therapy display engine configuredto: determine that the at least one renal failure therapy parameter andthe at least one infusion parameter are to be displayed at a combinationuser interface based on the patient identifier, determine a differenceparameter based on a difference between the at least one infusionparameter and the at least one renal failure therapy parameter, display,at the combination user interface, the at least one renal failuretherapy parameter within a renal failure therapy timeline, display, atthe combination user interface, the at least one infusion parameterwithin an infusion timeline that is aligned with the renal failuretherapy timeline, and display, at the combination user interface, thedifference parameter within a difference timeline that is aligned withthe renal failure therapy timeline and the infusion timeline.
 19. Theapparatus of claim 18, further comprising a display screencommunicatively coupled to the renal failure therapy display engine, thedisplay screen configured to display the combination user interface. 20.The apparatus of claim 14, wherein the infusion pump interface isconfigured to transmit a message, including the patient identifier, toat least one of the infusion pump or a gateway communicatively coupledto the infusion pump to receive the at least one infusion parameter andthe infusion time stamp.
 21. A hospital monitoring system comprising: aninfusion pump interface configured to receive at least one infusionparameter and a patient identifier from an infusion pump performing aninfusion treatment for a patient associated with the patient identifier;a renal failure therapy interface configured to receive at least onerenal failure therapy parameter and the patient identifier from a renalfailure therapy machine performing a renal failure therapy treatment forthe same patient; a vital sign monitor interface configured to receiveat least one physiological sensor parameter and the patient identifierfrom a vital sign monitor used for the same patient; an integrationengine configured to: determine that the at least one renal failuretherapy parameter, the at least one infusion parameter, and the at leastone physiological sensor parameter are to be displayed at a combinationuser interface based on the patient identifier, determine a differenceparameter based on a difference between the at least one infusionparameter and the at least one renal failure therapy parameter, display,at the combination user interface, information related to the at leastone renal failure therapy parameter, display, at the combination userinterface, information related to the at least one infusion parameter,display, at the combination user interface, information related to thedifference parameter, and display, at the combination user interface,information related to the at least one physiological sensor parameter.22. The system of claim 21, further comprising a clinician devicecommunicatively coupled to the integration engine, the clinician deviceconfigured to provide the combination user interface.
 23. The apparatusof claim 21, wherein the infusion pump interface is configured to:transmit a first message, including the patient identifier, to at leastone of the infusion pump or a gateway communicatively coupled to theinfusion pump to receive the at least one infusion parameter and theinfusion timestamp, and transmit a second message, including the patientidentifier, to at least one of the renal failure therapy machine or agateway communicatively coupled to the renal failure therapy machine toreceive the at least one renal failure therapy parameter and the renalfailure therapy timestamp.